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Appropriateness of invasive cardiovascular interventions in German hospitals (2000-2001): an evaluation using the
A Gandjour1, I Neumann, K W Lauterbach
1Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
Insights
German hospitals show low rates of inappropriate percutaneous transluminal coronary angioplasties (PTCAs) and coronary artery bypass grafts (CABGs). However, there may be underuse of pre-interventional stress tests for these cardiovascular procedures.
Area of Science:
- Cardiovascular medicine
- Health services research
- Medical procedure appropriateness
Background:
- Germany leads Europe in percutaneous transluminal coronary angioplasties (PTCAs) and ranks high in heart surgeries using heart-lung machines.
- High rates of invasive cardiovascular procedures necessitate evaluating their appropriateness.
Purpose of the Study:
- To assess the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals.
- To compare appropriateness rates with international benchmarks.
Main Methods:
- Retrospective study of 361 patients across 121 randomly selected German hospitals (December 2000 - August 2001).
- Evaluation of 128 PTCAs, 92 CABGs, and 141 CEAs using RAND appropriateness criteria.
Main Results:
- Low inappropriateness rates: 2% for PTCA, 4% for CABG, and 3% for CEA.
- High rate of uncertain procedures (42%).
- Only 38% of patients undergoing coronary intervention had a pre-interventional stress test.
Conclusions:
- Little overt overuse of PTCA, CABG, and CEA was observed in Germany.
- Significant potential underuse of pre-interventional stress tests was identified.
- Despite high procedural volumes, inappropriate procedure rates were comparable to other countries.
Objective:
Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart-lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals using RAND appropriateness criteria.
Methods:
A retrospective study in 121 randomly selected German hospitals (52 % of all hospitals contacted) was performed from December 2000 to August 2001. A total of 361 patients were enrolled providing information on the appropriateness of 128 PTCAs, 92 CABGs, and 141 CEAs.
Results:
Inappropriateness rates were 2 % (95 % CI 0 - 5 %), 4 % (95 % CI 1 - 9 %), and 3 % (95 % CI 1 - 7 %) for PTCA, CABG, and CEA, respectively. The overall rate of uncertain procedures was 42 % (95 % CI 36 - 47 %). Only 38 % (95 % CI 32 - 45 %) of patients who received a coronary intervention had had a pre-interventional stress test.
Conclusions:
The study yielded little overt overuse in the performance of PTCAs, CABGs, and CEAs, but potentially large underuse of stress tests. Despite a high per capita rate of invasive cardiovascular interventions in Germany, the rate of inappropriate procedures was not larger than in other countries.
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